# HEAVENLY MANOR ELDERLY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770953499
- **Authorized official:** MRS. MARIAM KRATIAN (OWNER)
- **Authorized official phone:** (818) 434-3089

## Contact information

- **Practice address:** 7708 ETHEL AVE., NORTH HOLLYWOOD, CA 91605-0000
- **Practice address phone:** (818) 434-3089
- **Practice address fax:** (818) 765-7791
- **Mailing address:** 7708 ETHEL AVE., NORTH HOLLYWOOD, CA 91605-0000
- **Mailing address phone:** (818) 434-3089
- **Mailing address fax:** (818) 765-7791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 197608684 | CA | Yes |

## Other

- **Enumeration date:** 10/07/2015
- **Last updated:** 10/07/2015